In Reply.—I thank Dr Pfau for the interest he has taken in our work. As mentioned in the article, our study was designed and started in 1981, when most researchers defined "significant urinary tract infection" as a colony count of ≥105 or ≥104 colony forming units per milliliter of midstream urine.1 Lower bacterial counts correlate with true infection of the bladder, and the relevance of this finding to our results is discussed in the comment to our article. In a recent study, urinary tract infections with low bacterial counts responded better to therapy than urinary tract infections with high bacterial counts.2 Thus the question as to whether a low colony count in urine has the same clinical significance as a high count may still be open.

As to the second point raised by Dr Pfau, although suprapubic aspiration is sometimes indicated in women with recurrent